Provider Demographics
NPI:1427278860
Name:ONEILL, PATRICIA JOAN (MSN,APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:ONEILL
Suffix:
Gender:F
Credentials:MSN,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 OLD NEW YORK RD
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:NJ
Mailing Address - Zip Code:08241-9731
Mailing Address - Country:US
Mailing Address - Phone:609-240-3320
Mailing Address - Fax:609-404-0631
Practice Address - Street 1:762 OLD NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:NJ
Practice Address - Zip Code:08241-9731
Practice Address - Country:US
Practice Address - Phone:609-240-3320
Practice Address - Fax:609-404-0631
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC07525400364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8101400Medicaid
028900Medicare ID - Type Unspecified